[cineva]

Hello,

I found this forum while searching on google. While clicking here and there, I found some useful & interesting info ... so I thought I'll ask a question that I couldn't find any info by searching:

How can you get insured if you already have lupus? (do you tell them, or you hold on it?)

I was diagnosed with lupus in Europe, but now I live in California and I am trying to figure out what insurance should I apply for, and what should I look into the plans they offer.

I don't have any symptoms right now, but since in US the health industry costs soooo much, I am trying to be prepared for anything.

as I said I live in California, can any of you help me with this? I would appreciate it very much!

Thank you in advance

(I hope I posted in the right category)

 

[Clare.T]

Welcome to the forum
I am sorry that I can't help you with your question because I have no relevant experience of health insurance in the USA. Just from general knowledge, it is very hard to get any sort of insurance anywhere with an SLE diagnosis except at a high premium. Also I am pretty sure that if you do not declare it your insurance would be invalid.
Anyway I hope someone will come along who can be more use. There might already be threads on Living with Lupus or USA Disability sections.


All the best
Clare

 

[suebehar]

Hi, I live in California and Clare is correct. It is impossible to obtain private health insurance with SLE. However, if you are working or your husband is working, and your employers offer health insurance, you must be accepted, even with pre-existing conditions. The state of California also offers high risk insurance policies (they really only cover major expenses and with a high deductible) for people who can't get privately insured. That is why it is so important for the US and President Obama to continue to make healthcare a priority.
Take care,

Susan

 

[Barb G]

Have you received health care in the US yet? If you have, did you inform your provider you have been diagnosed with lupus?

If no one knows you have lupus, get covered by a health insurance policy ASAP, before the fact you have lupus becomes known by the US healthcare system. If your diagnosis is known, try to get the best coverage you can, preferably through an employer.

 

[Maia]

I would not hide the diagnosis while applying for insurance, because you will pay your premiums and then when you need them to pay a big claim someday they'll tell you that because you "lied" or "withheld" information from them that your policy is invalid and will deny the claim and then withdraw coverage from you.

With a SLE diagnosis... the only ways to get health care coverage in the US is through an employer provided insurance policy, through a high risk state pool (usually much too expensive to afford still), or through a program like Medicaid for the poor. Good luck to you!

Oh, and welcome to the site!

 

[Pink Pearl]

I would want to know if you have been treated for lupus, medications taken included, in the last 90 days. If you have NOT, then you are not dealing with a pre-existing condition. If you have, then you need to declare the lupus and lupus meds, lab works, all additional related conditions could be not covered for up to a year.

It will also matter if you are going for an individual plan or a group plan. The criteria for individual policies are more limiting than a group plan.
Are you old enough to qualify for any umbrella groups such as a medicare supplement from AARP?

If you are not able to get coverage in a group plan, then you would do well to go for the state benefit program. Premiums differ per income level.
Sally

 

[onetay]

Hi and welcome to the site. Health insurance is impossible to get once you have a chronic illness. You may even find it hard to get insurance from either yours or your husband insurance company also. I to live in the usa and where I live and work I can get insurance from work but the sle was a pre-existing condition so they will not pay for anything to do with the lupus and since anything can be linked to the sle even a cold it is pointless for me to pay for insurance at this point. You should not withhold the info about the lupus because if you do and they find out then they can cancell you and refuse to pay any outstanding medical bills. Be honest so both of you know what you are getting for your money. I do hope that this helps a little in some way.

 

[KarolH]

You have been given great advice here.

Certainly do not lie on a application.

That could come back to haunt you.

Good luck and let us know how you make out moving ahead.

Welcome to the forum.:wink2::wink2::wink2:

 

[cineva]

FIrst of all, I'd like to thank you all for the replies and great info


I was actually diagnosed with SLE about 2 years ago (the only symptoms I had or what they diagnosed me by, was the antibody levels, which were too high). I took plaquenil for 2 years (as directed by doctor, 1 pill per day, but I stopped taking it about 3 months ago).
My last lab tests (about 8 months ago) showed normal levels, so my SLE is not active.

I came to US 1 year ago, and I haven't applied for any insurance since then, so in other words the only place the insurance companies would be able to get any info about me or my SLE would be from immigration bureau (which I am not sure if they share such information).

Anyway, I was told (by the doctors in Europe) that if I'll ever get pregnant (I am 26 btw), I'll have to be checking regularly with a doctor, to make sure my SLE won't activate.

My husband is self-employed, so we would have to purchase the insurance ourselves.

Thank you again for all the replies and great info (I wasn't expecting that many to be honest), so thank you

 

[Pink Pearl]

Since you are in remission, then you may or may not have a flare if you get pregnant. At this point, then you don't need to inform the insurance that you have sle.

I processed health insurance claims for 12 years, set up the second cost containment program in a field office for a large ins co.
The common criteria for pre-existing conditions is if you have been treated within the previous 90 days, then the condition is often not covered for up to 1 year. Some confuse the treatment to not include medications. You have not taken anything in that limiting time period so I would not advertise sle, but not deny it if you are specifically asked. The criteria for private plans can be more limiting.

There are groups made up of independents who form alliances to be able to get a discount for group rates. ie: private electricians who create a group and then purchase insurance under a group rate. I know that there is a group of cattlemen in Washington who have formed an alliance for that specific purpose. A friend of mine is in this group.... Another friend was in a group of independent cosmetic dealers who did the same thing, so you might want to investigate to see if you could buy into this type of coverage. Then, you would not be subject to private ins criteria.
Sally

 

[Katharine]

Hello,

I don't know anything about U.S. insurance specifically but am currently in the middle of a court case because an idiot broker filled out a questionnaire wrongly and HIMSELF - I actually can't remember anything about taking out the insurance (just knew I had it) but now that I need that insurance, they won't pay at all because they claim that there were omissions in the questionnaire and therefore the contract is null.

They are currently trying to prove that when I signed the contract (2004) I knew I had a rheumatic disease - thankfully there they don't have a leg to stand on as in 2004 I had gone into remission and truly believed that any previous problems had been down to thyroid and a stressful job.

Katharine

 

[keebler]

Hi,

Welcome to the forum, it is nice to meet you.

I was wondering why you quit taking your plaq?

I agree with Maia that one should not keep health information from insurance company's. They can say you with held information and cancel or not pay for your claims.

Take care,
Lyn